Zika Health Alert - April 7, 2017

HEALTH ALERT

Summary

The Texas Department of State Health Services (DSHS) is modifying Zika Testing Criteria for Residents of the Lower Rio Grande Valley.

Testing is
recommended as part of routine prenatal care for pregnant residents of Cameron,
Hidalgo, Starr, Webb, Willacy, and Zapata counties at their first prenatal care
visit and again in the second trimester. In addition, if a pregnant woman
exhibits symptoms in any stage of her pregnancy, she should be tested (or
retested if tested already) for Zika.

Testing is
recommended for other residents of Cameron, Hidalgo, Starr, Webb, Willacy, and
Zapata counties who exhibit a rash and at least one other common Zika symptom,
either fever, joint pain, or conjunctivitis (eye redness).

Testing is available through many commercial labs and through the public health laboratories in the state.

Background

DSHS anticipated that the southernmost areas of the state would be most likely to support local mosquito transmission of Zika. In response, it expanded the testing threshold for symptomatic pregnant women in Cameron, Hidalgo, Starr, Webb, Willacy, and
Zapata counties in October 2016 to quickly diagnose and prevent further spread of the disease. After several cases of local mosquito-borne transmission in Brownsville, the largest city in Cameron County, DSHS recommended, as part of routine prenatal care, testing all pregnant
women residing in Brownsville or with travel to Brownsville on or after October 29, 2016.

A mild winter prevented a break in mosquito season in the southernmost areas of the Rio Grande Valley, and Zika virus transmission continues in Northern Mexico. Given the persistent risk, DSHS has further expanded its testing criteria applicable to all residents of Cameron,
Hidalgo, Starr, Webb, Willacy, and Zapata counties in order to rapidly identify and respond to new infections and protect the health and well-being of Texans in the Lower Rio Grande Valley.

Testing Criteria for Residents
of the Lower Rio Grande Valley

DSHS is asking the healthcare community to continue to help maximize Zika surveillance for residents of the Lower Rio Grande Valley, including the counties of Cameron, Hidalgo, Starr,
Webb, Willacy, and Zapata.

Testing is
recommended for all pregnant women at their first prenatal care visit and again
in the second trimester. In addition, if a pregnant woman exhibits symptoms at any point in her pregnancy, she should be tested (or retested if tested already) for Zika as soon as possible.

Previously, testing was recommended for pregnant women with two of the four most common Zika symptoms, unless the woman lived in or had traveled to Brownsville on or after October 29, 2016. These symptom criteria no longer apply to pregnant women.

Testing is
recommended for other residents of Cameron, Hidalgo, Starr, Webb, Willacy, and
Zapata counties who exhibit a rash (especially if itchy and widespread) and at
least one other common Zika symptom, either fever, joint pain, or
conjunctivitis (red eye).

Previously, testing was recommended for individuals with three of the four most common Zika symptoms, unless they had travel to areas of active Zika transmission.

Recommended testing criteria for other areas of the state have not changed at this time. (See
www.texaszika.org)

Specimens from individuals with health insurance or Medicaid should be tested using the normal mechanism for obtaining clinical laboratory testing and following the CDC testing algorithm. Many commercial laboratories perform Zika testing; however, for IgM positive tests, additional testing (PRNT) will need to be performed.

The ability to pay for testing should not be a barrier to testing, particularly for pregnant women. Testing is available through public health labs for individuals who have no payor source or for whom there is a financial barrier to testing. DSHS is committed to ensuring any pregnant woman at risk for Zika is
tested.

If the individual is not covered by private insurance or a third party payor, testing may be obtained through a DSHS laboratory. Instructions for how to submit specimens to the DSHS laboratories may be obtained through the TexasZika.org website under
the Laboratories link (http://texaszika.org/labs.htm).

DSHS continues to recommend preconception counseling be provided to patients contemplating having a baby. For full women's Zika prevention guidance, visit
http://texaszika.org/healthcareprof.htm.

DSHS continues to recommend that healthcare providers consult, as needed, with their local health department or DSHS Regional Office to facilitate appropriate test selection and submission of specimens.

Throughout the upcoming mosquito season, healthcare providers are advised to continue to stay abreast of the status of Zika in Texas and in their local communities.